Pomegranate is a red fruit with leathery skin and hundreds of edible seeds inside, each surrounded by juicy red flesh. The plant originated in the region spanning Iran to the Himalayas and has been cultivated for thousands of years across the Mediterranean, Middle East, and parts of Asia.

The fruit appears in Greek, Hebrew, Buddhist, Islamic, and Christian writings. Records from around 1500 BCE describe pomegranate being used to treat tapeworms and parasites. Today you can find it in juice form, as an extract in supplements, or eaten fresh when in season (typically September through February in the northern hemisphere).

What’s actually in pomegranate?

Pomegranate contains polyphenols, particularly punicalagins and ellagic acid, which are the compounds most researchers focus on. These are antioxidants, meaning they can neutralise reactive molecules that damage cells. The fruit also contains vitamin C, potassium, and fibre.

The juice has a distinctive tart-sweet flavour that comes from the combination of sugars and organic acids. Different parts of the fruit have been used traditionally: the seeds and surrounding flesh are eaten, while the peel and bark were historically used in folk medicine.

What does the research show?

I’ve gone through the clinical trials on pomegranate to separate what’s reasonably well-supported from what remains speculative.

1. Blood pressure reduction

This is probably the best-supported benefit. High blood pressure is the leading risk factor for cardiovascular disease, so even modest reductions matter. One analysis found that for every 2 to 5 mmHg drop in systolic blood pressure, stroke risk decreases by 11.5 to 13 per cent [1].

A meta-analysis of 8 randomised controlled trials with 574 participants found that pomegranate juice lowered both systolic and diastolic blood pressure regardless of dosage or duration [2]. The proposed mechanism involves reducing oxidative stress, improving the function of blood vessel lining cells, and affecting the angiotensin converting enzyme (the same pathway that ACE inhibitor medications target).

My honest take: this is one of the more consistent findings across studies. If you have mildly elevated blood pressure and enjoy pomegranate juice, there’s reasonable evidence it might help. I wouldn’t rely on it instead of medication if your doctor recommends treatment, but as part of a dietary approach it makes sense.

2. Blood sugar control in type 2 diabetes

Type 2 diabetes affects how the body processes glucose, the main source of energy for cells. When glucose metabolism goes wrong, it affects not just blood sugar but potentially the brain, kidneys, eyes, and cardiovascular system.

A double-blind controlled study of 85 people with type 2 diabetes found that fresh pomegranate juice helped lower fasting blood sugar, improved pancreatic beta cell function, and reduced insulin resistance [3]. Interestingly, the benefits appeared regardless of gender but decreased with age.

The mechanism may involve polyphenols affecting how the body responds to insulin. Pomegranate has also been shown to inhibit alpha-glucosidase, an enzyme that breaks down carbohydrates, which could slow glucose absorption after meals [4].

One thing to keep in mind: pomegranate juice does contain natural sugars. If you’re monitoring carbohydrate intake, the juice might not be ideal compared to whole fruit or an extract supplement. About 240ml of pomegranate juice contains roughly 32 grams of sugar.

3. Anti-inflammatory effects

Chronic inflammation is associated with numerous conditions including non-alcoholic fatty liver disease, type 2 diabetes, and cardiovascular disease. Animal studies have found that pomegranate juice has anti-inflammatory effects, working through pathways involving nuclear transcription factors NF-kB and PPARs [5].

However, a meta-analysis of 5 human studies with 427 participants found that pomegranate juice had no significant effect on C-reactive protein (CRP), a common marker of inflammation [6]. Sensitivity analysis suggested that removing one study conducted outside Iran did show a benefit, which the authors speculated might reflect genetic differences in how people respond to pomegranate compounds.

I’m somewhat sceptical here. The human evidence is mixed at best. If you’re taking pomegranate hoping it will reduce inflammation, the data doesn’t strongly support that expectation.

4. Cholesterol and blood lipids

High cholesterol is another cardiovascular risk factor, often occurring alongside metabolic syndrome and obesity. Animal studies found that compounds in pomegranate (gallic acid and linoleic acid) had lipid-lowering effects in animals fed high-fat diets [7].

But human evidence tells a different story. A meta-analysis of 12 studies with 545 participants found that pomegranate juice had no significant effect on total cholesterol, LDL cholesterol, HDL cholesterol, or triglycerides [8]. Larger studies might show something, but based on current evidence I wouldn’t take pomegranate specifically for cholesterol management.

5. Erectile dysfunction

Erectile dysfunction affects roughly 50 to 70 per cent of men between ages 40 and 79. Risk factors include smoking, diabetes, high blood pressure, and high cholesterol [9]. The thinking behind pomegranate for this condition is that its antioxidant properties might improve blood flow by reducing fibrosis, enhancing nitric oxide availability, and reducing atherosclerotic plaque [10].

A double-blind controlled study of 53 patients with mild to moderate erectile dysfunction gave them pomegranate juice for 4 weeks. The results showed improvement that wasn’t statistically significant when measured by standard questionnaires (the International Erectile Function Index and Global Assessment Questionnaire), but there was a positive trend [11].

My honest assessment: the signal is weak. One small study with non-significant results isn’t compelling evidence. If pomegranate has benefits here, they’re likely subtle. The arginine evidence is somewhat stronger for this indication.

Side effects and safety concerns

Pomegranate is generally safe when consumed as food. The juice tastes pleasant and most people tolerate it well. However, there are several things worth knowing.

Digestive issues

Drinking large amounts of pomegranate juice can cause nausea, vomiting, abdominal pain, and diarrhoea. These symptoms typically resolve within a few hours. Some people find the juice irritates their gastrointestinal tract, particularly if consumed on an empty stomach.

Allergic reactions

Though uncommon, some people are allergic to pomegranate. Symptoms can include difficulty swallowing, skin rashes, hives, facial swelling, and breathing difficulties. If you experience any of these after consuming pomegranate, seek medical attention.

Sugar content

While pomegranate contains beneficial compounds, the juice is relatively high in calories and sugar. If you’re watching your weight or managing diabetes through carbohydrate restriction, whole fruit or extracts might be preferable to juice.

Enzyme interactions

Pomegranate can affect liver enzymes, particularly the cytochrome P450 system. This means it could potentially alter how your body processes certain medications. If you take medications metabolised by the liver, including some painkillers, anti-inflammatory drugs, psychiatric medications, and antiemetics, discuss pomegranate with your pharmacist before consuming it regularly.

Drug interactions to watch for

Do not combine pomegranate supplements with:

Anticoagulants and antiplatelet medications (warfarin, aspirin, clopidogrel): Pomegranate may enhance blood-thinning effects, increasing bleeding risk
Blood pressure medications: Pomegranate’s own blood pressure-lowering effect could combine with medication to cause excessive drops
Statins and other lipid-lowering drugs: Potential for interactions affecting drug levels

Who should be cautious

Pregnant women, breastfeeding mothers, and people with liver or kidney problems should consult a healthcare provider before taking pomegranate supplements. Eating the fruit occasionally as food is generally fine, but concentrated supplements deliver much higher doses of active compounds.

The bottom line

Pomegranate has the strongest evidence for modest blood pressure reduction. There’s reasonable evidence for blood sugar benefits in diabetics, though you need to account for the juice’s own sugar content. The inflammation, cholesterol, and erectile function evidence is weaker.

If you enjoy pomegranate juice, there’s no reason to avoid it and some reason to think it’s beneficial for cardiovascular health. I wouldn’t expect dramatic effects or rely on it for serious health conditions, but as part of a varied diet it’s a reasonable choice.

For concentrated supplements, the evidence becomes less clear since most studies used juice rather than extracts. If you’re considering supplements, check for potential drug interactions first.

12 Benefits and side effects of resveratrol - another polyphenol-rich antioxidant
5 Benefits of grape seed extract - similar cardiovascular applications
22 Benefits of fish oil - another well-studied cardiovascular supplement

References

MacMahon S, Peto R, Collins R, et al. Blood pressure, stroke, and coronary heart disease. Part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990;335(8692):765-774. https://pubmed.ncbi.nlm.nih.gov/1969518/
Sahebkar A, Ferri C, Giorgini P, et al. Effects of pomegranate juice on blood pressure: A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res. 2017;115:149-161. https://pubmed.ncbi.nlm.nih.gov/27888156/
Sohrab G, Nasrollahzadeh J, Zand H, et al. Effects of pomegranate juice consumption on blood pressure and lipid profile in patients with type 2 diabetes: A single-blind randomized clinical trial. Clin Nutr ESPEN. 2014;9(4):e185-e191. https://pubmed.ncbi.nlm.nih.gov/25223711/
Katz SR, Newman RA, Lansky EP. Punica granatum: heuristic treatment for diabetes mellitus. J Med Food. 2007;10(2):213-217. https://pubmed.ncbi.nlm.nih.gov/17651054/
Lansky EP, Newman RA. Punica granatum (pomegranate) and its potential for prevention and treatment of inflammation and cancer. J Ethnopharmacol. 2007;109(2):177-206. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2562783/
Sahebkar A, Gurban C, Serban A, et al. Effects of supplementation with pomegranate juice on plasma C-reactive protein concentrations: A systematic review and meta-analysis of randomized controlled trials. Phytomedicine. 2016;23(11):1095-1102. https://pubmed.ncbi.nlm.nih.gov/26922037/
Bagri P, Ali M, Aeri V, et al. Antidiabetic effect of Punica granatum flowers: effect on hyperlipidemia, pancreatic cells lipid peroxidation and antioxidant enzymes in experimental diabetes. Food Chem Toxicol. 2009;47(1):50-54. https://pubmed.ncbi.nlm.nih.gov/18571153/
Sahebkar A, Simental-Mendía LE, Giorgini P, et al. Lipid profile changes after pomegranate consumption: A systematic review and meta-analysis of randomized controlled trials. Phytomedicine. 2016;23(11):1103-1112. https://pubmed.ncbi.nlm.nih.gov/26857863/
Shamloul R, Ghanem H. Erectile dysfunction. Lancet. 2013;381(9861):153-165. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4291852/
Forest CP, Padma-Nathan H, Liker HR. Efficacy and safety of pomegranate juice on improvement of erectile dysfunction in male patients with mild to moderate erectile dysfunction: a randomized, placebo-controlled, double-blind, crossover study. Int J Impot Res. 2007;19(6):564-567. https://pubmed.ncbi.nlm.nih.gov/16626982/
Forest CP, Padma-Nathan H, Liker HR. Efficacy and safety of pomegranate juice on improvement of erectile dysfunction in male patients with mild to moderate erectile dysfunction: a randomized, placebo-controlled, double-blind, crossover study. Int J Impot Res. 2007;19(6):564-567. https://pubmed.ncbi.nlm.nih.gov/17568759/
NHS. Vitamins and minerals - Others. https://www.nhs.uk/conditions/vitamins-and-minerals/others/
Mayo Clinic. Pomegranate. https://www.mayoclinic.org/drugs-supplements-pomegranate/art-20399143